Introduction:

Children who are sick with degenerative muscle disorders (such as Duchenne Muscular Dystrophy) are eligible for a disabled child benefit.
Eligibility can be determined by medical documentation only, without requiring the child to appear before a medical committee
For more information see the National Insurance Institute website

Children who are sick with degenerative muscle disorders are eligible for a disabled child benefit.

  • The National Insurance Institute circular from 05.02.2015 provides guidelines for determining eligibility based on the child's condition:
  • A child who needs supervision:
    • Eligibility is for a benefit of 50% (if there isn't a claim for additional eligibility).
    • Eligibility begins from the time of diagnosis and when clinical symptoms begin, showing the need for supervision.
  • A child who needs a specific drug treatment:
    • When a child requires at least 3 of the 7 treatments listed on the Disabled Child Benefit for Children Requiring Special Medical Treatment page, he is eligible for a benefit of 100%.
    • This eligibility is for situations when drug treatment needs to be given everyday, in addition to supervision and follow-up at the specialist clinic.
    • Eligibility begins when the child begins these specific treatments (for example treatment with steroids or cardiotonics).
  • A child who is completely dependent on another person:
    • A child who is in the more progressed stages of the disease and is completely reliant on another person to perform daily activities.
    • Eligibility in this case is for a benefit amount of 188% (the maximum amount).
  • Children receive a standing eligibility but their parents can request a re-examination at any stage of the process if their is deterioration in the medical or functional situation of their child.
  • The general process for receiving the benefit and the details of each step of the process are found in the charts below.
Receiving notification about the decision of the committee
If the answer is positive, see, Benefit Rates
In any case, you may
reapply

Who is Eligible?

  • A child from age 91 days through 18 years, that is sick with one of the following:
    • Duchenne Muscular Dystrophy
    • Becker muscular dystrophy (BMD)
    • Limb-girdle muscular dystrophies (LGMD)
    • Congenital muscular dystrophies (CMD)
    • Facioscapulohumeral muscular dystrophy (FSHD)
    • Myotonic dystrophy (DM)
    • Oculopharyngeal muscular dystrophy (OPMD)
    • Distal muscular dystrophy (DD)
    • Emery-Dreifuss muscular dystrophy (EDMD)
  • Additionally the child has to meet the general disabled child benefit conditions. (See the additional conditions of eligibility section on the disabled child benefit page.

Necessary Preparations

Necessary Documentation

  • Up to date medical documentation regarding the child's medical and functional situation including medical history, treatment type and frequency.
  • Follow up report from the specialist clinic including details for upcoming treatment plans.
  • A child on a respirator - diagnosis from the attending doctor including ventilation instructions, type of machine and date that regular ventilation began.

How to Claim It?

  • In accordance with the National Insurance Institute circular, eligibility can be determined by the medical documentation submitted with the claim without requiring the child to appear before a medical committee.
  • In a case where there are discrepancies between the medical documentations the child may be asked to come for a check in order to make a decision about the case.
What Now? For Further Details Notes
Submit a claim Submitting a Disabled Child Benefit Claim It is important to remember to send all required documents
After filing the claim, it will be decided if a decision on the amount of disability can be made without the presence of the child. Medical Committee Hearing Without the Presence of the Child. If the committee decides on eligibility based on documentation only, you can request that the child be checked by the committee within 45 days.
If it is decided after filing the claim that there is a need to check the child then an invitation to a medical committee hearing will be sent according to the age of the child. *Medical Committee for a Disabled Child up to Age 3 *It is important to arrive at the prescribed time, or to report the inability to attend in advance.
  • If the child does not need assistance in performing daily activities, you can request that these activities are not checked during the committee's examination.
The committee's decision Within 45 days of receiving the claim with all relevant documents, you will be sent the decision, together with the minutes of the medical committee meeting. In certain situations, temporary eligibility may be established (relevant cases are detailed in the Specific Information for Eligible Populations section.
  • In cases where temporary disability is established, towards the end of the established period of disability, the National Insurance Institute will request updated medical information and the person will be invited to appear before an additional medical committee.
If eligibility is granted, the benefit will be paid from the month in which the claim was submitted The benefit will be transferred to the eligible recipient's bank account on the 28th of each month.
Retroactive Payment Retroactive payment for up to a year before the claim was submitted may granted if the conditions for eligibility existed before submission. The time is determined based on the earlier of these two dates:
  • The date in which the symptoms connected to the child's disability were first recorded in the child's medical records.
  • The date in which that child's disability began to cause a significant and heavy treatment load (according to a pediatrician who works on behalf of the National Insurance Institute).
*A child receiving the benefit because of a developmental delay (until age 3) may receive a retroactive benefit for up to half a year before the claim was filed.
  • A retroactive benefit is not automatic and should be requested along with the main claim submission.
If you are not satisfied with the decision (if eligibility was rejected or only partially/temporarily established), you can appeal within 90 days from the day it was received. Appealing the Decision of the Medical Committee for a Disabled Child
If you are not satisfied with the decision of the Appeals Committee, you can appeal within 60 days to the Regional Labor Court. Appealing the Decision of the Medical Appeals Committee of the National Insurance Institute You may requestfree legal assistance from the legal assistance division of the Ministry of Justice.
A repeat claim may be filed after 6 months, or if there has been a deterioration in health status - with no waiting period. Submitting a Disabled Child Benefit Repeat Claim
If your child (above age 3) is totally dependent on the assistance of others for daily activities (in a way that is significantly more than his/her peers) and the child receives a disabled child benefit without relating to this dependence, a dependence evaluation can be requested. Dependence Evaluation for a Disabled Child Benefit Recipient A request for a dependence evaluation can be submitted from age 2 years and 10 months.


Benefit Amounts

  • The Disabled Child Benefit at the rate of 188% is 4,757 NIS (this amount includes the supplement amount of 580 NIS), correct as of 2019. (The supplement was raised retroactively from January 2018).


  • The Disabled Child Benefit at the rate of 100% is 2,600 NIS (this amount includes the supplement amount of 378 NIS), correct as of 2019.


  • The Disabled Child Benefit at the rate of 50% is 1,264 NIS, correct as of 2019. The amount includes a supplement of 153 NIS (the supplement is paid retroactively from January 2018).
  • A child who has 3 conditions that entitle him to a pension of 50% is entitled to a pension of 100%. For more information see the National Insurance Institute website.

Families with two or more disabled children

  • Families with two or more children entitled to the disabled child benefit are entitled to an increased benefit amount for each of the children.
  • The addition for each child is an additional 50% of entitled amount established for the child.
Example
A family in which one child is entitled to a benefit of 100% and the brother is entitled to a benefit of 50%:
  • The child that is entitled to a benefit of 100% will receive an increased benefit of 150%.
  • The child that is entitled to a benefit of 50% will receive an increased rate of 75%.
  • Families with two children with disabilities who only receive a Disabled Child Benefit for one of them are entitled to an increased benefit amount if the child for which they are not receiving the benefit is not eligible for it due to one of the following reasons:
    • S/he lives in an institution or other facility outside the home.
    • S/he is over the age of 18 and received a Disabled Child Benefit before reaching the age of 18.
  • Families where two children are eligible for a Disabled Child Benefit or where one child is eligible for a Disabled Child Benefit and the second is eligible for a Mobility Benefit may be entitled to both a Disabled Child Benefit and a Mobility Benefit for each of the children in accordance with each benefit's conditions of eligibility.


Please Note

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English translation and maintenance by The Shira Pransky Project.